How doctors should professionally behave on Twitter

According to one of the  the guidelines set forth by the AMA about professionalism in social media, “When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions.”

With that in mind, Bryan Vartabedian, who blogs as DrV at 33 Charts, publicly illustrated a Twitter stream that he deemed unprofessional.

I won’t recap it here, but instead go over to the thread and read about the controversy, as well as the comments, now numbering over 130.

Was it actually unprofessional?  Some doctors think not.  Emergency physician Shadowfax, for instance, notes the subjective nature of professionalism, and says,

if you look at the actual conversation nothing more was disclosed beyond the diagnosis, lack of risk factors, and the duration of symptoms. That’s hardly a lot of detail. I should also point out that she expresses significant empathy for the patient which is to her credit.

But, as others have have noted, did it pass the proverbial “elevator test?”  Meaning, if a physician verbalized the offending tweets in a crowded hospital elevator, would it be unprofessional?

A physician openly discussing an anonymous patient’s penile condition doesn’t pass such an elevator test, in my opinion, and is inappropriate.  I agree with Wendy Sue Swanson when she says, doctors “need to aim above HIPAA.”

So, although the content may not have technically breached patient privacy, physicians need to behave at a higher standard online.  Unfair? Perhaps, but that comes with the territory of being a doctor with an online persona, especially when the boundaries of professional social media etiquette are so unsettled.

And finally, does such a Tweet benefit the patient at all?  I’d say no.  Physicians should weigh that above all else when deciding to “blow off steam,” or express to the world what’s on their mind at a particular moment.

Some have asked me, “How would you have handled it?”

I probably would have reached out to the offending physician privately, rather than in a public forum.  No one likes to be called out.  The physician in question has been clearly affected, and has even lost sleep over this episode.  But I understand that DrV doesn’t generally engage anonymous online entities, and I respect that.

There are certainly benefits to conducting the dialogue publicly.  It’s hit a nerve, and the discourse has been instructive.

If this episode moves us one step closer to better defining how doctors should behave professionally on Twitter, I’d say that’s a good thing.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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